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Bottino N, Marino A, Polli F, Savioli M, Tubiolo D, Iapichino GE, Protti A, Gattinoni L. Unexpected left atrial reinfusion through a patent foramen ovale during venovenous extracorporeal life support. Anaesth Intensive Care 2016; 44:637-9. [PMID: 27608350 DOI: 10.1177/0310057x1604400516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- N Bottino
- Anesthesist/ICU doctor, Dipartimento di Anestesia, Rianimazione e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - A Marino
- Fellow, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università deg li Studi di Milano, Milan, Italy
| | - F Polli
- Anesthesist / ICU doctor, Dipartimento di Anestesia, Rianimazione e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - M Savioli
- Anesthesist/ICU doctor, Dipartimento di Anestesia, Rianimazione e Terapia dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - D Tubiolo
- Anesthesist/ICU doctor, Dipartimento di Anestesia, Rianimazione e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - G E Iapichino
- Fellow, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università deg li Studi di Milano, Milan, Italy
| | - A Protti
- Anesthesist / ICU doctor, Dipartimento di Anestesia, Rianimazione e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - L Gattinoni
- Professor, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università deg li Studi di, Milan, Italy
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Karbing DS, Panigada M, Bottino N, Spinelli E, Protti A, Rees' SE, Gattinoni L. Changes in computed tomography and ventilation/perfusion mismatch with positive end-expiratory pressure. Crit Care 2014. [PMCID: PMC4069987 DOI: 10.1186/cc13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Spinelli E, Crotti S, Zacchetti L, Bottino N, Berto V, Russo R, Chierichetti M, Protti A, Gattinoni L. Effect of extracorporeal CO2 removal on respiratory rate in spontaneously breathing patients with chronic obstructive pulmonary disease exacerbation. Crit Care 2013. [PMCID: PMC3642471 DOI: 10.1186/cc12066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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De Chiara S, Chiumello D, Nicolini R, Vigorelli M, Cesana B, Bottino N, Giurati G, Caspani ML, Gattinoni L. Prolongation of antibiotic prophylaxis after clean and clean-contaminated surgery and surgical site infection. Minerva Anestesiol 2010; 76:413-419. [PMID: 20473254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM Several guidelines have recommended that antibiotic prophylaxis (AMP) should be given only at premedication, except in selected cases. Conversely, in clinical practice, AMP is often unnecessarily prolonged after the surgical procedure. In this observational study, we evaluated the risk of surgical site infection (SSI) associated with the prolongation of AMP after clean and clean-contaminated surgery. METHODS All consecutive patients who underwent a surgical procedure were eligible. AMP was always administered before the surgical incision. Prolongation of AMP for the first 24 hours was allowed only in presence of at least one risk factor for SSI: an ASA score >2 or surgical procedure longer than the specific cutoff (as indicated by the NNIS--the National Nosocomial Infections Surveillance System). SSIs were evaluated during the hospital stay and after hospital discharge. RESULTS Three hundred fifty-eight patients were enrolled; 19 (5.3%) and 17 (6.5%) patients developed respectively intra-hospital and post hospital discharge SSIs. AMP prolongation for 24 hours in patients with at least one risk factor did not reduce the risk for intra-hospital SSI (OR 1.102; 95% CI: 0.336-3.612; P=0.873), while it increased the risk in patients without risk factors (OR: 8.99; 95% CI: 1.46-55.4; P=0.018). AMP longer than 24 hours raised the risk for intra-hospital and post hospital discharge SSI, regardless of the presence of risk factors (OR: 3.39; 95% CI 1.11-10.35; P=0.032 and OR: 5.39; 95% CI: 1.64-17.75; P=0.006, respectively.) CONCLUSION Postoperative AMP prolongation should be avoided.
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Affiliation(s)
- S De Chiara
- Department of General Resuscitation, Institute of Anesthesia and Resuscitation University of Milan, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Milan, Italy.
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Chiumello D, Bottino N, Cressoni M, Racagni M, Landi L, D'adda A, Polli F, Terragni S, Gattinoni L. Crit Care 2005; 9:P111. [DOI: 10.1186/cc3174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Valenza F, Guglielmi M, Gatti S, Bottino N, Giacomini S, Irace M, Tedesco C, Maffioletti M, Maccagni P, Gattinoni L. Effects of continuous negative abdominal pressure on intrathoracic blood shift with and without increased intra-abdominal pressure: experimental study. Crit Care 2003. [PMCID: PMC3301627 DOI: 10.1186/cc2071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- F Valenza
- Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano – IRCCS, via F. Sforza n. 35, 20122, Milano, Italy
| | - M Guglielmi
- Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano – IRCCS, via F. Sforza n. 35, 20122, Milano, Italy
| | - S Gatti
- Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano – IRCCS, via F. Sforza n. 35, 20122, Milano, Italy
| | - N Bottino
- Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano – IRCCS, via F. Sforza n. 35, 20122, Milano, Italy
| | - S Giacomini
- Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano – IRCCS, via F. Sforza n. 35, 20122, Milano, Italy
| | - M Irace
- Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano – IRCCS, via F. Sforza n. 35, 20122, Milano, Italy
| | - C Tedesco
- Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano – IRCCS, via F. Sforza n. 35, 20122, Milano, Italy
| | - M Maffioletti
- Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano – IRCCS, via F. Sforza n. 35, 20122, Milano, Italy
| | - P Maccagni
- Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano – IRCCS, via F. Sforza n. 35, 20122, Milano, Italy
| | - L Gattinoni
- Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano – IRCCS, via F. Sforza n. 35, 20122, Milano, Italy
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Valenza F, Bottino N, Chiumello D, Li Bassi G, Storelli E, Russo R, Canavesi K, Gattinoni L. Crit Care 2003; 7:P181. [DOI: 10.1186/cc2070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chiumello D, Carlesso E, Storelli E, Li Bassi G, Vagginelli F, Bottino N, Gattinoni L. Crit Care 2003; 7:P164. [DOI: 10.1186/cc2053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pelosi P, Chiumello D, Calvi E, Taccone P, Bottino N, Panigada M, Cadringher P, Gattinoni L. Effects of different continuous positive airway pressure devices and periodic hyperinflations on respiratory function. Crit Care Med 2001; 29:1683-9. [PMID: 11546965 DOI: 10.1097/00003246-200109000-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the effect on respiratory function of different continuous positive airway pressure systems and periodic hyperinflations in patients with respiratory failure. DESIGN Prospective SETTING Hospital intensive care unit. PATIENTS Sixteen intubated patients (eight men and eight women, age 54 +/- 18 yrs, PaO2/FiO2 277 +/- 58 torr, positive end-expiratory pressure 6.2 +/- 2.0 cm H2O). INTERVENTIONS We evaluated continuous flow positive airway pressure systems with high or low flow plus a reservoir bag equipped with spring-loaded mechanical or underwater seal positive end-expiratory pressure valve and a continuous positive airway pressure by a Servo 300 C ventilator with or without periodic hyperinflations (three assisted breaths per minute with constant inspiratory pressure of 30 cm H2O over positive end-expiratory pressure). MEASUREMENTS AND MAIN RESULTS We measured the respiratory pattern, work of breathing, dyspnea sensation, end-expiratory lung volume, and gas exchange. We found the following: a) Work of breathing and gas exchange were comparable between continuous flow systems; b) the ventilator continuous positive airway pressure was not different compared with continuous flow systems; and c) continuous positive airway pressure with periodic hyperinflations reduced work of breathing (10.7 +/- 9.5 vs. 6.3 +/- 5.7 J/min, p <.05) and dyspnea sensation (1.6 +/- 1.2 vs. 1.1 +/- 0.8 cm, p <.05) increased end-expiratory lung volume (1.6 +/- 0.8 vs. 2.0 +/- 0.9 L, p <.05) and PaO2 (100 +/- 21 vs. 120 +/- 25 torr, p <.05) compared with ventilator continuous positive airway pressure. CONCLUSIONS The continuous flow positive airway pressure systems tested are equally efficient; a ventilator can provide satisfactory continuous positive airway pressure; and the use of periodic hyperinflations during continuous positive airway pressure can improve respiratory function and reduce the work of breathing.
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Affiliation(s)
- P Pelosi
- Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi dell'Insubria, Varese, Italy
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Chiara O, Pelosi P, Segala M, Turconi MG, Brazzi L, Bottino N, Taccone P, Zambelli M, Tiberio G, Boswell S, Scalea TM. Mesenteric and renal oxygen transport during hemorrhage and reperfusion: evaluation of optimal goals for resuscitation. J Trauma 2001; 51:356-62. [PMID: 11493800 DOI: 10.1097/00005373-200108000-00023] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Changes in flow to the gut and the kidney during hemorrhage and resuscitation contribute to organ dysfunction and outcome. We evaluated regional and splanchnic oxygen (O2) flow distribution and calculated oxygen supply distribution during hemorrhage and reperfusion and compared them with global measures. METHODS Seven anesthetized pigs were instrumented to evaluate global hemodynamics, visceral blood flow, and oxygen transport. Tonometric pH probes were positioned in the stomach and jejunum. Animals were bled to 45 mm Hg for 1 hour. Crystalloids and blood were infused during the following 2 hours to normalize blood pressure, heart rate, urine output, and hemo- globin. RESULTS During hemorrhage, mesenteric flow and O2 consumption were significantly decreased, whereas systemic consumption remained normal. Renal flow was reduced, but renal O2 consumption remained normal. After resuscitation, despite normal hemodynamics, neither systemic, mesenteric, nor renal O2 delivery returned to baseline. Lactate remained significantly increased. Arterial pH, base excess, and gastric and jejunal pH were all decreased. CONCLUSION During hemorrhage, the gut is more prone than other regions to O2 consumption supply dependency. After resuscitation, standard clinical parameters do not detect residual O2 debt. Lactate, arterial pH, base excess, and intramucosal gut pH are all markers of residual tissue hypoperfusion.
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Affiliation(s)
- O Chiara
- Istituto di Chirurgia d'Urgenza, Universita' degli Studi di Milano, Ospedale Maggiore IRCCS, Milano, Italy
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Chiumello D, Taccone P, Civardi L, Calvi E, Mondino M, Bottino N, Caironi P. Patient controlled pressure support ventilation. Crit Care 2001. [PMCID: PMC3333210 DOI: 10.1186/cc1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Pelosi P, Aspesi M, Franchi D, Colombo G, Gamberoni C, Caironi P, Bottino N. [Mechanical ventilation in acute respiratory distress syndrome. New Trends]. Minerva Anestesiol 2000; 66:875-82. [PMID: 11235648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Adult Respiratory Distress Syndrome (ARDS) is characterized by an inflammatory process affecting endothelial and epithelial lung tissue, with occurrence of hypoxemia, bilateral X-ray infiltrates, in absence of cardiogenic edema. The introduction of Computerized Tomography brought some improvements in understanding the ARDS lung, leading to a pulmonary model made up of three zones: 1) normally inflated, 2) recruitable and 3) consolidated. It has now been well established that mechanical ventilation of ARDS lung presents some iatrogenic effects that may affect mortality. Several mechanisms are considered responsible of ventilator-associated lung injury (VALI): high inspired oxygen fraction, high inspiratory plateau pressure and large tidal volume, and intratidal collapse and reinflation of alveolar units. In these years, different ventilatory strategies in the treatment of ARDS patients have been suggested to decrease and to prevent VALI. The most important one seems to be the application of an appropriate value of tidal volume and positive end-expiratory pressure (PEEP). Several randomized studies, which compared low versus high tidal volumes, have recently been finished. Despite some differences, it seems that a ventilatory management limiting inspiratory plateau pressure to 35 cmH2O or lower may be useful to reduce VALI and mortality, also in association with a PEEP level sufficient to decrease the end-expiratory collapse. Another useful ventilatory tool for improving gas exchange and decreasing VALI in ARDS patients is likely the prone positioning, even if further studies are necessary to understand how this maneuver may really affect mortality. Another therapeutic instrument for improving oxygenation in ARDS patients is the inhalation of NO. Unfortunately, this pharmacological agent does not seem to affect the outcome of these patients.
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Affiliation(s)
- P Pelosi
- Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi, Insubria, Varese
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Pelosi P, Caironi P, Bottino N, Gattinoni L. [Positive end expiratory pressure in anesthesia]. Minerva Anestesiol 2000; 66:297-306. [PMID: 10965706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
It is well established that general anesthesia, with or without paralysis, causes profound changes in respiratory function. From a clinical point of view, the more important consequence of this impairment is a decreased efficiency of gas exchange, with a decreased blood oxygenation. The main reason of this respiratory embarrassment is the intraoperative occurrence of atelectasis, mainly in the dependent lung regions. The amount of atelectasis, computed through Computerized Tomography, correlates with the amount of intrapulmonary shunt; thus, alveolar collapse and ventilation/perfusion mismatching are considered the most important factors for poor respiratory function. This deterioration seems also to play a crucial role in obese patients, who have poorer respiratory function and gas exchange than normal subjects already in physiological conditions. Different ventilatory approaches have been tried to resolve and eventually prevent the anesthesia-induced atelectasis. In normal subjects, the sole application of positive end-expiratory pressure (PEEP) seems to be an useless tool for improving gas exchange, probably because of changes in hemodynamics functions. The only effective application of PEEP seems to be in association to an alveolar recruitment manoeuvre. As the anesthesia-induced atelectasis are also present in the postoperative period, this ventilatory approach may also be used to prevent this condition. In obese patients PEEP seems to have a major effectiveness than in normal subjects, with an improvement of lung volumes, respiratory mechanics, gas exchange and an occurrence of recruitment. However, further studies are necessary to define optimal value of PEEP and tidal volume for different types of patients.
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Affiliation(s)
- P Pelosi
- Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi dell'Insubria, Varese
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Brazzi L, Bottino N, Eccher G, Panigada M, Gattinoni L. Ventilator settings in acute respiratory failure/acute respiratory distress syndrome. Monaldi Arch Chest Dis 2000; 55:84-6. [PMID: 10786432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Affiliation(s)
- L Brazzi
- Istituto di Anestesia e Rianimazione, Ospedale Maggiore IRCCS, Milan, Italy
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Bottino N, Chiaravalli L, Panigada M, Carrieri F, Allegritti E, Pelosi P, Gattinoni L. In vitro study of a new vaporization humidifying device: DAR HC 2000®. Crit Care 2000. [PMCID: PMC3333031 DOI: 10.1186/cc827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chiumello D, Pelosi P, Bottino N, Calvi E, Taccone P, Gattinoni L. Evaluation of different CPAP systems in ICU population. Crit Care 2000. [PMCID: PMC3333026 DOI: 10.1186/cc822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bottino N, Panigada M, Chiumello D, Pelosi P, Gattinoni L. Effects of artificial changes in chest wall compliance on respiratory mechanics and gas exchange in patients with acute lung injury (ALI). Crit Care 2000. [PMCID: PMC3333041 DOI: 10.1186/cc837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bottino N, Eccher G, Pelosi P, McKibben A, Adams A, Goldner M, Marini JJ, Gattinoni L. Influence of different PEEP levels and tidal volumes on the regional nonaerated tissue: experimental study. Crit Care 2000. [PMCID: PMC3333047 DOI: 10.1186/cc843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- N Bottino
- 1st. Anestesia e Rianimazione, Osp. Maggiore Policlinico-IRCCS, via F. Sforza, 35, 20122, Milano, Italy
| | - G Eccher
- 1st. Anestesia e Rianimazione, Osp. Maggiore Policlinico-IRCCS, via F. Sforza, 35, 20122, Milano, Italy
| | - P Pelosi
- Dip. Scienze Cliniche e Biologiche, Univ. dell'Insubria, Varese, Italy
| | - A McKibben
- University of Minnesota, St Paul, MN, USA
| | - A Adams
- University of Minnesota, St Paul, MN, USA
| | - M Goldner
- University of Minnesota, St Paul, MN, USA
| | - JJ Marini
- University of Minnesota, St Paul, MN, USA
| | - L Gattinoni
- 1st. Anestesia e Rianimazione, Osp. Maggiore Policlinico-IRCCS, via F. Sforza, 35, 20122, Milano, Italy
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Bottino N, Eccher G, Pelosi P, McKibben A, Adams A, Goldner M, Marini JJ, Gattinoni L. Relationship between superimposed pressure and pleural pressure gradient in an experimental model of ARDS. Crit Care 2000. [PMCID: PMC3333039 DOI: 10.1186/cc835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pelosi P, Ravagnan I, Giurati G, Panigada M, Bottino N, Tredici S, Eccher G, Gattinoni L. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 1999; 91:1221-31. [PMID: 10551570 DOI: 10.1097/00000542-199911000-00011] [Citation(s) in RCA: 281] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Morbidly obese patients, during anesthesia and paralysis, experience more severe impairment of respiratory mechanics and gas exchange than normal subjects. The authors hypothesized that positive end-expiratory pressure (PEEP) induces different responses in normal subjects (n = 9; body mass index < 25 kg/m2) versus obese patients (n = 9; body mass index > 40 kg/m2). METHODS The authors measured lung volumes (helium technique), the elastances of the respiratory system, lung, and chest wall, the pressure-volume curves (occlusion technique and esophageal balloon), and the intraabdominal pressure (intrabladder catheter) at PEEP 0 and 10 cm H2O in paralyzed, anesthetized postoperative patients in the intensive care unit or operating room after abdominal surgery. RESULTS At PEEP 0 cm H2O, obese patients had lower lung volume (0.59 +/- 0.17 vs. 2.15 +/- 0.58 l [mean +/- SD], P < 0.01); higher elastances of the respiratory system (26.8 +/- 4.2 vs. 16.4 +/- 3.6 cm H2O/l, P < 0.01), lung (17.4 +/- 4.5 vs. 10.3 +/- 3.2 cm H2O/l, P < 0.01), and chest wall (9.4 +/- 3.0 vs. 6.1 +/- 1.4 cm H2O/l, P < 0.01); and higher intraabdominal pressure (18.8 +/-7.8 vs. 9.0 +/- 2.4 cm H2O, P < 0.01) than normal subjects. The arterial oxygen tension was significantly lower (110 +/- 30 vs. 218 +/- 47 mmHg, P < 0.01; inspired oxygen fraction = 50%), and the arterial carbon dioxide tension significantly higher (37.8 +/- 6.8 vs. 28.4 +/- 3.1, P < 0.01) in obese patients compared with normal subjects. Increasing PEEP to 10 cm H2O significantly reduced elastances of the respiratory system, lung, and chest wall in obese patients but not in normal subjects. The pressure-volume curves were shifted upward and to the left in obese patients but were unchanged in normal subjects. The oxygenation increased with PEEP in obese patients (from 110 +/-30 to 130 +/- 28 mmHg, P < 0.01) but was unchanged in normal subjects. The oxygenation changes were significantly correlated with alveolar recruitment (r = 0.81, P < 0.01). CONCLUSIONS During anesthesia and paralysis, PEEP improves respiratory function in morbidly obese patients but not in normal subjects.
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Affiliation(s)
- P Pelosi
- Istituto di Anestesia e Rianimazione, Università di Milano, Ospedale Magiore, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
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Pelosi P, Bottino N, Panigada M, Eccher G, Gattinoni L. [The sigh in ARDS (acute respiratory distress syndrome)]. Minerva Anestesiol 1999; 65:313-7. [PMID: 10389410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
We studied 10 consecutive, sedated and paralyzed patients with Acute Respiratory Distress Syndrome (ARDS). The entire study lasted 4 hours, divided in 3 periods: 2 hours of recommended ventilation [lung protective strategy, LPS, i.e., ventilation with low tidal volume (< 8 mL/kg), limiting the plateau at 35 cm H2O, together with high positive end-expiratory pressure (PEEP)], 1 hour of sigh (LPS with 3 consecutive sighs/min at 45 cm H2O plateau pressure), and 1 hour of LPS. Total minute ventilation, PEEP, FiO2 and mean airway pressure were kept constant. The introduction of sighs induced a consistent recruitment and PaO2 improvement, and a decrease in venous admixture and PaCO2. Interrupting sighs and resuming LPS led to a progressive derecruitment, and all the physiological variables returned to baseline. Derecruitment was higher in patients with higher PaCO2 and lower VA/Q ratio. We conclude that: 1) LPS alone does not provide full lung recruitment and best oxygenation in ARDS; 2) application of sigh may provide pressure enough to recruit and volume enough to prevent reabsorption atelectasis.
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Affiliation(s)
- P Pelosi
- Istituto di Anestesia e Rianimazione, Policlinico IRCCS, Ospedale Maggiore, Milano
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Pelosi P, Cadringher P, Bottino N, Panigada M, Carrieri F, Riva E, Lissoni A, Gattinoni L. Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med 1999; 159:872-80. [PMID: 10051265 DOI: 10.1164/ajrccm.159.3.9802090] [Citation(s) in RCA: 208] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Mechanical ventilation with plateau pressure lower than 35 cm H2O and high positive end-expiratory pressure (PEEP) has been recommended as lung protective strategy. Ten patients with ARDS (five from pulmonary [p] and five from extrapulmonary [exp] origin), underwent 2 h of lung protective strategy, 1 h of lung protective strategy with three consecutive sighs/min at 45 cm H2O plateau pressure, and 1 h of lung protective strategy. Total minute ventilation, PEEP (14.0 +/- 2.2 cm H2O), inspiratory oxygen fraction, and mean airway pressure were kept constant. After 1 h of sigh we found that: (1) PaO2 increased (from 92.8 +/- 18.6 to 137.6 +/- 23.9 mm Hg, p < 0.01), venous admixture and PaCO2 decreased (from 38 +/- 12 to 28 +/- 14%, p < 0.01; and from 52.7 +/- 19.4 to 49.1 +/- 18.4 mm Hg, p < 0.05, respectively); (2) end-expiratory lung volume increased (from 1.49 +/- 0.58 to 1.91 +/- 0.67 L, p < 0.01), and was significantly correlated with the oxygenation (r = 0.82, p < 0.01) and lung elastance (r = 0.76, p < 0.01) improvement. Sigh was more effective in ARDSexp than in ARDSp. After 1 h of sigh interruption, all the physiologic variables returned to baseline. The derecruitment was correlated with PaCO2 (r = 0.86, p < 0.01). We conclude that: (1) lung protective strategy alone at the PEEP level used in this study may not provide full lung recruitment and best oxygenation; (2) application of sigh during lung protective strategy may improve recruitment and oxygenation.
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Affiliation(s)
- P Pelosi
- Istituto di Anestesia e Rianimazione, Università di Milano and Servizio di Anestesia e Rianimazione, Ospedale Maggiore IRCCS, Milano, Italy
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